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Chapter 3

Medicare Woes Take High Toll on Mentally Ill

Medicare Woes Take High Toll on Mentally Ill

This activity contains 3 questions.

	What are some of the unintended negative results that low income mentally ill people have encountered as they are being transitioned from Medicaid to Medicare part D for their prescription drug needs?   "For the first time, [mentally ill] residents...[are] being charged co-payments for their drugs, typically $3 for each prescription. The residents take an average of eight or nine drugs, so the co-payments can take a large share of their cash allowance, which is $54 a month." "Some of the pharmacists have been saying, 'No pills unless we get a co-payment.' ...many of [the] residents were forgoing their medications on account of the new co-payments." "Because of their mental illness,"..."they don't have the insight to realize the consequences of not taking their medications...they will definitely go into the hospital." ...patients with schizophrenia had gone to a hospital emergency room because they could not get their medications..."relapse is becoming more frequent" among...low-income Medicare patients. "We have seen some increase in admissions, and anticipate a lot more," as people wrestle with the new drug benefit. ...the transition from Medicaid to Medicare had had a particularly severe impact on low-income patients with serious, persistent mental illnesses. "Relapse, rehospitalization and disruption of essential treatment are some of the consequences,"

	What are some of the shortfall of the new Medicare part D policy and its implementation that have contributed to the negative impact of the policy on low income mentally ill people?   "...in many cases, pharmacists say, they still cannot get the information needed to submit claims, to verify eligibility or to calculate the correct co-payments for low-income people. And often, they say, they must wait for hours when they try to reach insurers by telephone." "Under the 2003 Medicare law, low-income people entitled to both Medicare and Medicaid are exempted from all co-payments if they live in a nursing home. But the exemption does not apply to people in assisted living centers..." "Most of the residents are on Medicare, because they have disabilities, and Medicaid, because they have low incomes. Before Jan. 1, the state's Medicaid program covered their drugs at no charge. Since then, the residents have been covered by a private insurance company under contract to Medicare. Sponsors of the 2003 Medicare law wanted to drive down costs by creating a competitive market for drug insurance. They focused on older Americans, not the disabled. They assumed that beneficiaries would sort through various drug plans to find the one that best met their needs. But that assumption appears unrealistic for people [with mental illness]." "Medicare's free-standing prescription drug plans are not responsible for the costs of hospital care or doctors' services. They have no business incentive to worry about those costs," said Dr. Joseph J. Parks, "...many... Medicare patients had been unable to get medicines or had experienced delays."

	What steps have Federal and State governments, agencies.....taken to less the negative impacts on low income mentally ill recipients of Medicare part D?   "Federal officials said they were moving aggressively to fix problems with the drug benefit. About 250 federal employees have been enlisted as caseworkers to help individual patients. The government has told insurers to provide a temporary supply - typically 30 days - of any prescription that a person was previously taking. And Medicare has sent data files to insurers, supposedly listing all low-income people entitled to extra help with premiums and co-payments." "At least 24 states have taken emergency action to pay for prescription drugs if people cannot obtain them by using the new Medicare drug benefit." "Florida Agency for Health Care Administration, said: "We've set up a phone line and an e-mail address for pharmacists. We try to solve these problems on a case-by-case basis. We have stepped in to get drug plans to pay for prescriptions, so people don't leave the pharmacy without their medications."

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